Long-term outcomes in syncope patients presenting to the emergency department: A systematic review.

INTRODUCTION Long-term outcomes among syncope patients are not well studied to guide physicians regarding outpatient testing and follow-up. The objective of this study was to conduct a systematic review for outcomes at 1-year or later among ED syncope patients. METHODS We searched Cochrane Central, Medline, Medline in Process, PubMed, Embase, and the Cumulative Index to Nursing databases from inception to December 2018. We included studies that reported long-term outcomes among ED syncope patients. We excluded studies on patients <16 years old, studies that included syncope mimickers (pre-syncope, seizure, intoxication, loss of consciousness after head trauma), case reports, letters to the editor, non-English and review articles. Outcomes included death, syncope recurrence requiring hospitalization, arrhythmias and procedural interventions for arrhythmias. Meta-analysis was performed by pooling the outcomes using random effects model. RESULTS Initial literature search generated 2,094 articles duplicate removal. Of the 50 articles selected for full-text review, 19 articles with 98,211 patients were included in this review: of which 12 were included in the 1-year outcome meta-analysis. Pooled analysis showed : 7.0% mortality; 16.0% syncope recurrence requiring hospitalization; 6.0% with device insertion. 1-year arrhythmias reported in two studies were 1.1 and 26.4%. Pooled analysis for outcome at 31 to 365 days showed: 5.0% mortality and 1% device insertion. Two studies reported 4.9% and 21% mortality at 30 months and 4.2 years follow-up. CONCLUSIONS An important proportion of ED syncope patients suffer long-term morbidity and mortality. Appropriate follow-up is needed and future research to identify patients at risk is needed.

[1]  M. Taljaard,et al.  Duration of Electrocardiographic Monitoring of Emergency Department Patients With Syncope , 2019, Circulation.

[2]  G. Hindricks,et al.  Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope , 2018, European heart journal.

[3]  Christophe Leclercq,et al.  2018 ESC Guidelines for the diagnosis and management of syncope , 2018, European heart journal.

[4]  B. Rowe,et al.  Syncope Prognosis Based on Emergency Department Diagnosis: A Prospective Cohort Study , 2018, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[5]  E. Montero,et al.  Prognosis of patients with syncope seen in the emergency room department: an evaluation of four different risk scores recommended by the European Society of Cardiology guidelines , 2017, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[6]  R. Sandhu,et al.  A Population-Based Cohort Study Evaluating Outcomes and Costs for Syncope Presentations to the Emergency Department. , 2017, JACC. Clinical electrophysiology.

[7]  R. Sant'anna,et al.  Simple risk stratification score for prognosis of syncope , 2016, Journal of Interventional Cardiac Electrophysiology.

[8]  A. R. Godinho,et al.  Transient loss of consciousness assessment in a University Hospital: From diagnosis to prognosis. , 2016, Porto biomedical journal.

[9]  M. Hlatky,et al.  Syncope and Motor Vehicle Crash Risk: A Danish Nationwide Study. , 2016, JAMA internal medicine.

[10]  S. Vanni,et al.  Assessment of a structured management pathway for patients referred to the Emergency Department for syncope: results in a tertiary hospital. , 2016, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[11]  M. Taljaard,et al.  Short-term risk of arrhythmias among emergency department syncope patients with non-sinus rhythm. , 2015, International journal of cardiology.

[12]  R. Furlan,et al.  Syncope recurrence and mortality: a systematic review. , 2015, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[13]  G. Barón-Esquivias,et al.  Prognostic value of the electrocardiogram in patients with syncope: data from the group for syncope study in the emergency room (GESINUR). , 2014, Heart rhythm.

[14]  G. Lippi,et al.  Evaluation of the current prognostic role of heart diseases in the history of patients with syncope. , 2014, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[15]  I. Stiell,et al.  Risk stratification of adult emergency department syncope patients to predict short-term serious outcomes after discharge (RiSEDS) study , 2014, BMC Emergency Medicine.

[16]  L. Køber,et al.  Evaluation of the CHADS2 Risk Score on Short‐ and Long‐Term All‐Cause and Cardiovascular Mortality After Syncope , 2013, Clinical cardiology.

[17]  M. Reed,et al.  Sensitive troponin assay predicts outcome in syncope , 2012, Emergency Medicine Journal.

[18]  Michelle Fiander,et al.  THE EFFECT OF ENGLISH-LANGUAGE RESTRICTION ON SYSTEMATIC REVIEW-BASED META-ANALYSES: A SYSTEMATIC REVIEW OF EMPIRICAL STUDIES , 2012, International Journal of Technology Assessment in Health Care.

[19]  D. Newby,et al.  One-year prognosis after syncope and the failure of the ROSE decision instrument to predict one-year adverse events. , 2011, Annals of emergency medicine.

[20]  C. Morillo,et al.  Application Of The American College Of Emergency Physicians (ACEP) Recommendations And a Risk Stratification Score (OESIL) For Patients With Syncope Admitted From The Emergency Department , 2011, Indian pacing and electrophysiology journal.

[21]  C. Mussi,et al.  Early and late outcome of treated patients referred for syncope to emergency department: the EGSYS 2 follow-up study. , 2010, European heart journal.

[22]  David E Newby,et al.  The ROSE (risk stratification of syncope in the emergency department) study. , 2010, Journal of the American College of Cardiology.

[23]  M. Brignole,et al.  Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score , 2008, Heart.

[24]  I. Stiell,et al.  Death after emergency department visits for syncope: how common and can it be predicted? , 2008, Annals of emergency medicine.

[25]  A. Katz,et al.  Admission for syncope: evaluation, cost and prognosis according to etiology. , 2008, The Israel Medical Association journal : IMAJ.

[26]  R. Furlan,et al.  Short- and long-term prognosis of syncope, risk factors, and role of hospital admission: results from the STePS (Short-Term Prognosis of Syncope) study. , 2008, Journal of the American College of Cardiology.

[27]  B. Ibáñez,et al.  Utility of in-hospital cardiac remote telemetry in patients with unexplained syncope. , 2007, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[28]  A. Kelly,et al.  External validation of the San Francisco Syncope Rule in the Australian context. , 2007, CJEM.

[29]  I. Stiell,et al.  Prospective Validation of the San Francisco Syncope Rule to Predict Patients With Serious Outcomes , 2006 .

[30]  C. Mussi,et al.  A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. , 2005, European heart journal.

[31]  B. Gersh,et al.  Syncope Evaluation in the Emergency Department Study (SEEDS) , 2004, Circulation.

[32]  M. Heller,et al.  Do patients with a negative Emergency Department evaluation for syncope require hospital admission? , 2004, The Journal of emergency medicine.

[33]  Peter Jüni,et al.  Direction and impact of language bias in meta-analyses of controlled trials: empirical study. , 2002, International journal of epidemiology.

[34]  A. Maggioni,et al.  Relevance of heart rate as a prognostic factor in patients with acute myocardial infarction: insights from the GISSI-2 study. , 1998, European heart journal.

[35]  B. Hanusa,et al.  Risk stratification of patients with syncope. , 1997, Annals of emergency medicine.

[36]  Abrar H. Shah,et al.  Corrected QT interval as a predictor of mortality in elderly patients with syncope. , 2011, Cardiology journal.

[37]  E. Feraco,et al.  The cardiogenic syncope in the elderly: a review on the epidemiology and social costs. , 1995, Archives of gerontology and geriatrics.